Drug-resistant tuberculosis: challenges and opportunities for diagnosis and treatment

Graphical abstract

Highlights

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  Management of tuberculosis is complicated by high levels of drug resistance in some regions of the world.

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  Increasingly, molecular diagnostics are being used for resistance detection to certain first-line anti-TB drugs.

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  Genotype-phenotype relationships for resistance to other drugs are complex making DST by molecular methods challenging.

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  Individualized approaches to MDR-TB treatment management may help to minimize the development of further resistance.

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  Individualized approaches to MDR-TB treatment management may help to minimize the development of further resistance.

Abstract

With an estimated incidence of 490 000 cases in 2016, multidrug resistant tuberculosis (TB), against which key first-line anti-tuberculars are less efficacious, presents major challenges for global health. Poor treatment outcomes coupled with a yawning treatment gap between those in need of second-line therapy and those who receive it, underscore the urgent need for new approaches to tackle the scourge of drug-resistant TB. Against this background, significant progress has been made in understanding the complex biology of TB drug resistance and disease pathogenesis, and in establishing a pipeline for delivering new drugs and drug combinations. In this review, we highlight the challenges of drug-resistant TB and the ways in which new advances could be harnessed to improve treatment outcomes.